New Student Data Collection Form

Student Details

Surname* Forename* Legal Surname Middlename Previous Surname Chosen Name Home Address* Post Code*

Gender*MaleFemale

Date of Birth*

Present School Details

Name of Present School* Address of Present School* Postcode of Present School* Contact Number of Present School* Date of Arrival at Present School

In Care

Select one of the following*YesNo

Parent/Carer Details

Single Parent*YesNo

Contact Number*

Contact Details

Please you the following boxes to give details of ALL persons who have parental responsibility, and anyone else you wish to be contacted in an emergency.

Please list them in the order you wish them to be contacted in an emergency.

*Please include parents.*

CONTACT 1

Contact 1 Name* Home Address* Post Code* Mobile Number* Daytime/Work Number Daytime/Work Address (if different from home) Relationship to Student*

Parental Responsibility*YesNo

Additional Contact Details

Please use the following boxes as required:

CONTACT 2

Contact 2 Name Home Address Postcode Mobile Number Daytime/Work Number Daytime/Work Address (if different from home) Relationship to Student

Parental ResponsibilityYesNo

CONTACT 3

Contact 3 Name Home Address Postcode Mobile Number Daytime/Work Number Daytime/Work Address (if different from home) Relationship to Student

Parental ResponsibilityYesNo

CONTACT 4

Contact 4 Name Home Address Postcode Mobile Number Daytime/Work Number Daytime/Work Address (if different from home) Relationship to Student

Parental ResponsibilityYesNo

Sibling Students

Any sibling student already on roll*YesNo

Name of Sibling (if applicable) Year & Form (if applicable) Name of Second Sibling (if applicable) Year & Form of Second Sibling (if applicable)

Medical Information

Doctor Name* Address* Contact Number* Any Medical Information Appropriate

Travel Arrangements

Meal Arrangements

Select one of the following*School MealSandwichesHomeFree School Meal

Dietary Requirements

Ethnic Origins

Select one of the following*

Religion

Select one of the following*

Asylum Status

Select one of the following*Not ApplicableAsylum SeekerRefugee

National Identity

Select one of the following*

Language

Select one of the following*

Free School Meals Entitlement

NB. Please indicate entitlement even if your child does not take up the entitlement*YesNo

English Additional Language

Select one of the following*YesNoNot Known

First Language

Please indicate ie English, other than English*

Nationality

Please enter*

Country of Birth

Please enter*

Service Child (ie Army, Navy, RAF)

Select one of the followingYesNo

Photograph/Video Request

During the course of the school year, there are occasions when photographs/videos are taken of students during lessons, activities and trips. These photographs/videos are used by school in materials such as the school website, newsletters, displays and brochures. Please indicate whether or note we have your permission for photographs/videos of your child to be used in these ways.*Yes, I give permissionNo, I do not give permission

New Student Data Collection Form

Student Details

Present School Details

In Care

Parent/Carer Details

Contact Details

Additional Contact Details

Sibling Students

Medical Information

Travel Arrangements

Meal Arrangements

Dietary Requirements

Ethnic Origins

Religion

Asylum Status

National Identity

Language

Free School Meals Entitlement

English Additional Language

First Language

Nationality

Country of Birth

Service Child (ie Army, Navy, RAF)

Photograph/Video Request

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